20 countries about to fall off Gavi funding ‘cliff,’ risking their ability to pay for life-saving vaccines for children long term

Photo by Brendan Bannon

MSF calls on Gavi to put children’s health at the centre of its funding model – not just economics

28 November 2017 - As the board of directors of Gavi, the Vaccine Alliance, meets this week in Vientiane, Laos, the international medical humanitarian organisation Médecins Sans Frontières (MSF) is calling on Gavi to ensure sustainable access to lifesaving vaccines by putting children’s health at the centre of its funding model. Among other topics, the board will discuss how to deal with countries that are in the process of losing Gavi support.

Gavi determines countries’ eligibility for support on the sole basis of gross national income (GNI) per capita (with a current threshold of US$ 1,580 on average over the past three years). As national income crosses this threshold, countries start to lose Gavi support over a five-year period and are expected to increase domestic financing for immunisation programmes. At the end of this ‘transition’ process, countries are expected to pay for vaccines and immunisation programmes entirely on their own.

By the end of 2020, twenty* countries will have fully lost Gavi funding. Sixteen countries will have lost funding by the end of 2017; eight** countries have done so already. A number of countries are scheduled to lose Gavi support despite poor or declining immunisation coverage (the proportion of children in a country who actually receive recommended vaccines).

Leaving children in these countries behind is counter to Gavi’s mission to save children’s lives and protect people’s health. Gavi has “identified a subset of countries that may require tailored strategies to support successful transition.” Its Board will consider plans for these countries when it meets this week.

"Children in twenty countries will run the risk of not being protected against childhood killers, as Gavi support is tapered off and countries struggle to pay for expensive vaccines. Instead of focusing on ad-hoc exceptions to its funding rules, the board should prove Gavi’s commitment to sustainability by fixing the funding model that put these countries on the brink in the first place. Measures of immunisation coverage should factor into eligibility and transition decisions for all Gavi countries. A country’s readiness to transition from donor funding cannot solely be assessed by economic criteria.

Gavi’s current rules fail to protect all children against killer diseases. Unvaccinated children remain unvaccinated: in 2016, nearly 1 in 10 children globally did not receive a single vaccine, leaving them unprotected against deadly diseases.

For more than 40 years, MSF has been delivering vaccines largely to compensate for poor immunisation coverage and outbreaks caused by weak immunisation systems. We continue to witness the significant gaps in reaching infants with even the basic package of vaccines, particularly in some of these countries that are losing Gavi support.

Gavi needs to improve its funding model and urgently address the structural gaps in the routine immunisation systems of countries transitioning out from support. Why should countries lose Gavi's full support when their children still need it?”

As an international medical humanitarian organisation, vaccination is a key part of MSF’s work. Each year, our teams vaccinate millions of people, both as a response to outbreaks of diseases such as measles, meningitis, yellow fever and cholera, and through routine immunisation activities in projects where we provide health care to mothers and children. During 2016, MSF vaccinated more than 2.2 million people in response to outbreaks and nearly half a million more for routine immunisation.